Successful treatment of horseshoe fistula requires deroofing of deep postanal space

A total of 24 patients underwent treatment for horseshoe fistula-in-ano. In 3 patients the disease was bilateral; in 21 unilateral. Treatment consisted of deroofing the postanal space with division of overlying external sphincter muscle by seton. In 22 cases (92%), lateral wings were deroofed. At 23 months (range: 5 to 45 months), 23 cases (96%) have healed. Five (21%) have required reoperation: one remains unhealed. Mean healing time was 3.5 months (1 to 13). Five patients wear a protective pad, but 14 (64%) consider their continence normal. A total of 13 patients consider their result excellent, 9 good, 1 fair, and 1 a failure. Good to excellent results of treatment of horseshoe fistula and complete healing may be achieved in 92% of cases by a method that includes deroofing the deep postanal space and lateral wings.